Bone marrow puncture &

transplantation

Prof. Dr. dr. Adi Priyana SpPK

Bag. Patologi klinik

 Transplantasi sst

Prosedur medis untuk sst yang rusak diganti

dengan sel induk sst yang baru.
Jenis kanker darah yang umum diobati dengan
transplantasi sst adalah lekemia dan limfoma.
Efek samping yang sering: mual, muntah,
kerusakan hati, perdarahan, infeksi, rambut
rontok.
Prosesnya disebut harvesting (panen).
Diusahakan donor berasal dari saudara dekat
sehingga dapat dihindari proses graft versus host
disease (GVHD).
Bone marrow aspiration and biopsy
are now well-accepted procedures for
evaluation both the cellularity of the marrow and the
nature of the cells present. Although sternum (breast
bone) is the traditional site for bone marrow aspiration (but
not for biopsy), our preferred site is the posterior Iliac crest
(the hip bone) because of ease and safety and the fact
that the posterior Iliac crest is usually quite cellular.
CONTRAINDICATIONS:
 Hemophilia and other Clotting disorder
 Previous Radiation Therapy site.
INDICATIONS:
 Unexplained anemia. Decreased presence of red blood cells,
the cause of which may be a variety of reasons, the most
common being deficiency of iron stores and Myelodysplasia.
 Thrombocytopenia. Decreased production of platelets, I.T.P.
(or Idiopathic Thrombocytopenia) being most
common. Physicians determine if adequate number of platelet
producing cells (Megakaryocytes) are present in the bone
marrow.
 Pancytopenia. Decreased production of all three cell lines,
differentiates relative involvement of red cell, white cell and
platelet lines in a disease.
 Leukemia, Lymphoma, or Myeloma (helpful in diagnoses,
staging and determining results of the treatment)
 Lympho and Myeloproliferative disorders.
 Metastatic disease. To determine if bone marrow is involved
with cancers from other sites.
 Chromosomal analyses
 Unusual infection. Such as Tuberculoses, Fungi and Fevers of
Unknown Origin
What are ‘Stem Cells’?

Stem cells are uncommitted, self renewing

cells, able to differentiate into many different
kinds of tissue.

TWO different sources of stem cells

Embryonic Stem Cells (ESC): Early embryonic
(day 5-8 blastocyst cells) self renewing cells
‘Adult’ or Somatic stem cells (ASC): a minor
population of self renewing cells found in
most tissues
 Adult Stem Cells (ASC)
Problems with ESC mean that:
 ASC are the only practical approach to regenerative
therapy
 NO ETHICAL PROBLEMS
 Patients’ own cells can be used after expansion in
vitro: no rejection, therefore no immunosuppressive
drugs needed.
Source of Embryonic Stem Cells

Source: Scientific American, July 2005

Adult Stem Cells to Treat CVD

Current status of treatments

 Two different approaches to

therapy:
1) commercial, uncontrolled, for
profit
2) clinical trials, controlled, not
for profit
 Common Indications for Stem Cell Transplantation
Autologous Transplantation Allogeneic Transplantation
Malignant Disorders Nonmalignant Malignant Disorders Nonmalignant Disorders
Disorders

Multiple myeloma Autoimmune AML Aplastic Anemia

Neuroblastoma disorders Non-Hodgkin lymphoma Fanconi anemia
Non-Hodgkin lymphoma Amyloidosis Hodgkin disease SCID
Hodgkin disease ALL Thalassemia major
AML CML Diamond-Blackfan anemia
Medulloblastoma MDS Sickle cell anemia
Germ-cell tumors Multiple myeloma Wiskott-Aldrich Syndrome
CLL Osteopetrosis
Inborn errors of metabolism
Autoimmune disorders